| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $169.82 | $169.82 | $169.82 | |
Aetna
| Professional | $169.82 | $190.55 | $263.03 | |
Molina
| Professional | $50.12 | $60.26 | $85.11 | |
Providence
| Facility | $125.89 | $186.21 | $478.63 |
Alveoloplasty Not In Conjunction With Extractions - One To Three Teeth Or Tooth Spaces, Per Quadrant
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $169.82 | $169.82 | $169.82 | |
Aetna
| Professional | $169.82 | $190.55 | $263.03 | |
Molina
| Professional | $50.12 | $60.26 | $85.11 | |
Providence
| Facility | $125.89 | $186.21 | $478.63 |